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Musculoskeletal 2 > Knee Clinical Presentations > Flashcards

Knee Clinical Presentations Flashcards

1
Q

List common clinical presentations of the knee

A
  1. Patellar Fracture
  2. Tendon Rupture
  3. Osgood-Schlatter Disease
  4. Articular Cartilage Defects
  5. Meniscus lesion
  6. Cruciate and collateral ligament sprains
  7. Patellofemoral Instability
  8. Patellofemoral Pain syndrome
  9. Osteoarthropathy
  10. Arthrofibrosis
  11. Genu recurvatum
  12. Patellar Tendinopathy
  13. ITB friction syndrome
  14. Plica Syndrome
  15. Bursitis
  16. Peripheral Nerve entrapment
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2
Q

list the criterion for the Pittsburg Knee Decision Rule

A
  1. Pt Hx blunt trauma or fall
  2. Instability to bear weight x4 steps immediately and in ED
  3. age <12 OR >50
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3
Q

indications for a radiograph according to the Pittsburg Knee Decision Rule

A

Criterion 1

OR

Criterion 1 + Criterion 2 or 3

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4
Q

Criterion in the Ottawa Knee Decision Rule

A
  1. TTP head of fibula
  2. Instability to bear weight x4 steps immediately and in ED
  3. age >/= 55 years
  4. Inability to flex knee 90º
  5. Isolated TTP patella
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5
Q

indications for radiograph according to the Ottawa Knee Decision

A

any of the criterion observed

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6
Q

Epidemiology and Hx for Patellar Fractures

A
  1. Epidemiology
    • 1% of all fractures
    • most common 20-50 y/o
    • males 2x > females
    • >50% non-displaced
  2. Hx
    • common MOIs
      • fall onto anterior knee
      • sudden quad activation
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7
Q

symptomology of patellar fractures (2)

A
  1. painful/inability to extend knee
  2. anterior knee pain
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8
Q

physical exam findings for patellar fractures (5)

A
  1. palpable gap at fracture site
  2. local tenderness
  3. painful resistance testing > AROM for knee extension
  4. Painful end-range flexion ROM
  5. antalgic gait
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9
Q

epidemiology for Tendon Rupture: Patellar and Quad

A
  1. patellar tendon < 40 y/o commonly
  2. quad tendon > 40 y/o commonly
    • males 4-8x > females
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10
Q

risk factors for tendon ruptures (9)

A
  1. Local steroid injection
  2. Prolonged corticosteroid use
  3. RA
  4. Lupus
  5. CT diseases
  6. Infectious disease
  7. Arteriosclerosis
  8. DM
  9. Hyperthyroidism
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11
Q

Patellar and Quad Tendon Rupture History (5)

A
  1. related to eccentric overload extensor mechanism/trauma
  2. sudden onset f/b fall; hemarthrosis commonly observed
    • quad → commonly related to regaining balance/rapid quad contraction
    • patellar → jump landing common
  3. Hx degenerative tendinopathy common
  4. Hx TKA
  5. ACL reconstruction (patellar tendon graft)
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12
Q

Symptomology for Patellar and Quad Tendon Ruptures (1)

A

Anterior Knee pain

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13
Q

Physical exam findings for Patellar and Quad Tendon Ruptures (4)

A
  1. absent active knee extension vs painful active knee extensino
  2. painful knee flexion ROM
  3. palpable defect
  4. antalgic gait vs unable to ambulate
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14
Q

Epidemiology of Osgood-Schlatter’s disease (5)

A
  1. Apophysitis of tibial tubercle
  2. males > females
  3. common age onset:
    • males 10-15 y/o
    • females 8-13 y/o
  4. Repetitive loading of knee into flexion
  5. Radiology → calcification of tibial tubercle
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15
Q

Osgood-Schlatter’s disease History (2)

A
  1. adolescent athlete
  2. common bilaterally
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16
Q

symptomology of Osgood-Schlatter’s disease (2)

A
  1. anterior knee pain
  2. aggravated with activity/resisted knee extension
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17
Q

Physical exam findings for Osgood-Schlatter’s disease (5)

A
  1. local TTP
  2. prominent tibial tubercle on visual inspection
  3. pain end-range knee flexion ROM
  4. painful resistance testing with knee extension > AROM
  5. possibly pain with tuning fork
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18
Q

epidemiology for articular cartilage defects

A
  1. articular cartilage lesion prevalence 60-70%
  2. 32-58% non-contact trauma MOI
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19
Q

what is osteochondritis dissecans? (2)

A
  1. type of articular cartilage defect
    • separation of articular cartilage from subchondral bone
  2. open vs closed physes
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20
Q

osteochondritis dissecans occurs most in ______

  • age, gender*
  • area of knee*
  • is it unilateral or bilateral?*
A
  1. Juveniles
    • lateral aspect of medial condyle most common site
    • males > females
    • greatest 10-20 y/o
    • active individuals
    • commonly bilaterally
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21
Q

Osteochondritis dissecans Hx (2)

  • when does the hemarthrosis occur?*
  • Is it traumatic usually?*
A
  1. traumatic MOI (40-60% juveniles) vs insidious onset
  2. hemarthrosis within 2 hours
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22
Q

symptomology of Osteochondritis dissecans (4)

A
  1. non-specific knee pain
  2. aggravated with activity, improves with rest
  3. stiffness/swelling with activities
  4. grinding, locking, catching
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23
Q

physical exam findings for osteochondritis dissecans (4)

A
  1. TTP femoral condyle/medial or lateral joint lines
  2. antalgic gait
  3. knee effusion
  4. limited/painful knee ROM
    • flexion
    • extension
24
Q

Surgical interventions for osteochonritis dissecans (6)

A
  1. arthroscopic lavage and debridement
  2. microfracture
  3. autologous osteochondral mosaicplasty grafting
  4. autologous chondrocyte implantation (ACI)
  5. osteochondral autograft transfer (OAT procedure)
  6. osteochondral allograft transplantation
25
Q

epidemiology of meniscus lesions (2)

  • What is the incidence?*
  • What are type of injury is common with them?*
A
  1. incidence = 12-14%
  2. concomitant ACL injury common
26
Q

Meniscus Lesions Hx (3)

  • when is the swelling?*
  • is it contact or non contact or degenerative?*
A
  1. contact vs non-contact injury vs degenerative
  2. audible “pop” during directional change
  3. delayed effusion
    • 6-24 hours following injury
27
Q

symptomology of meniscus lesions (2)

A
  1. catching, locking, giving way at knee
  2. local knee pain
28
Q

physical exam findings for meniscus lesions

A
  1. pain at end-range knee extension
  2. pain/limited flexion ROM
  3. pain/weak flexion and extension MMT
  4. joint line tenderness
  5. (+) McMurray’s Test
  6. (+) Thessaly Test
  7. (+) Appley’s Test
  8. Varus or Valgus test
29
Q

epidemiology of ACL lesions

A
  1. 250k ACL injuries occur in US each year
  2. Knee OA incidence as high as 78% = 14 yrs following ACL injury
  3. increase the risk for injury to other knee stabilizers
30
Q

Clinical correlates of ACL lesions (5)

A
  1. Females 2-9x > male
    • jump landing
    • Q angle
    • narrower intercondylar notch
    • hormones and laxity
  2. decreased hamstring or core strength
  3. duration of activity/fatigue
  4. dry/artifical turf
  5. high BMI
31
Q

ACL Lesion what are the common MOI’s for non contact vs. contact injury?

A
  1. Non-contact injury (more likely)
    • pivoting with planted foot and extended knee
    • deceleration and directional change/cutting
    • jump landing in full knee extension
    • hyperextension or hyperflexion of knee
  2. Contact Injury MOI
    • an application of varus/valgus force to the knee that imposes a shear force on the joint
32
Q

symptomology of ACL lesions (4)

A
  1. feeling of instability in knee
  2. C/O severe pain at the time of injury
  3. Audible pop with injury
  4. Report of immediate swelling at the time of injury (effusion)
33
Q

physical exam findings for ACL lesions (7)

what positive special tests? (3)

A
  1. weight-shifted posture (standing)
  2. knee joint effusion
  3. antalgic gait
  4. AROM and PROM painful/limited all planes (acutely)
  5. Boggy/guarded end feel
  6. MMT weak and painful all planes
  7. Excessive laxity w/KT-1000 arthrometer test
  8. (+) Pivot shift test
  9. (+) anterior drawer test
  10. (+) Lachman’s test
34
Q

Epidemiology for PCL spain

A
  1. Epidemiology
    • 3-20% of knee injuries
35
Q

Hx for PCL sprain

what are 3 common MOI’s?

A
  1. Audible pop with injury
  2. Common MOI
    • posterior force at proximal anterior tibia
    • violent hyperextension of knee
    • fall on flexed knee with PF
36
Q

Symptomology of PCL sprain

A
  1. local posterior knee pain aggravated with deceleration and kneeling
  2. feelings of LE giving way/instability
37
Q

physical exam findings for PCL sprains (5)

  • what phase/action of gait will be limited?*
  • What ROM will be limited?*
  • What will cause pain with resistive testing?*
A
  1. gait → limited knee extension in stance phase
  2. effusion
  3. (+) posterior drawer test
  4. limited/painful knee extension and flexion ROM
  5. painful with resistive testing of extension >90º
38
Q

epidemiology of MCL sprains (5)

  • What sports is it correlated with?*
  • What do high grade knee injuries lead to?*
A
  1. involved in ~42% of ligament injuries at the knee
  2. correlation with soccer, football, hockey
  3. high grade injuries may lead to chronic knee instability
  4. superficial vs deep
  5. common concomitant knee injuries
39
Q

MCL Sprain Hx

A
  1. Common MOI
    • valgus force (external force at lateral knee)
    • rotary trauma
    • younger > older
    • males 2x > female
40
Q

symptomology of MCL sprains

ie. what aggravates it and where is the pain?

A
  1. medial knee pain
  2. aggravated with:
    • activity
    • change in direction (ambulation)
    • valgus force at knee
41
Q

physical exam findings for MCL sprain

A
  1. swelling/bruising
  2. antalgic gait
  3. potential limited/painful knee ROM
  4. local TTP
  5. (+) valgus stress test (pain, laxity)
42
Q

LCL sprain Hx

ie. what is the common MOI

A
  1. common MOI
    • varus trauma at knee
43
Q

symptomology of LCL sprains (2)

A
  1. lateral knee pain
  2. aggravated with directional change during ambulation
44
Q

physical exam findings for LCL sprains (4)

A
  1. local lateral knee effusion
  2. TTP LCL
  3. (+) Varus stress test at 0 and 30 degrees knee flesion
  4. guarded/boggy end-feel with end-range ROM flexion and extension
45
Q

issues following Patellarfemoral Instability (3)

A
  1. Concern with tracking of patella and distribution of loading
  2. subsequent dislocation common
  3. concomitant osteochondral lesion common
46
Q

Predispositions for patellarfemoral (4)

A
  1. structural → smaller patella, shallow groove for patella (lateral ridge)
    • lateral tilt and lateral displacement toward extension (30º)
  2. Patella alta/baja
  3. quad muscle imbalance proposed (VMO/VL)
  4. generalized ligamentous laxity
47
Q

Hx for patellarfemoral instability

A

subluxation/dislocation of patellofemoral joint

48
Q

symptomology of patellofemoral instability (2)

A
  1. giving way of LE (reflex inhibition)
  2. peri-patellar pain
49
Q

Physical exam findings of patellofemoral instability (4)

where is the tenderness?

Is it hyper or hypo mobile?

Will there be swelling?

A
  1. peripatellar tenderness
  2. hypermobility of patellofemoral joint
  3. apprehension sign
  4. ecchymosis/swelling/effusion in more acute stage
50
Q

T/F: recurrent instability in patellofemoral instability is indicative for surgery

A

TRUE

51
Q

Clinical Correlates for PFPS

  • what weakness at hip is correlated?*
  • What knee musculature will be weak?*
A

Common among active individuals and adolescents

  1. altered patellar tracking thought to contribute to aberrant loading patterns of patellarfemoral joint
    • quad weakness/muscle imbalance
    • soft tissue tightness
    • increased Q-angle
    • Hip weakness (ABD and ER)
    • altered foot/ankle kinematics
52
Q

futher clinical correlates for PFPS (6)

A
  1. increased femoral angle of inclination
  2. increased femoral anteversion
  3. limited hip extensor endurance
  4. VMO weakness (controversial)
  5. Hip ER and ABD weakness
  6. Subtalar pronation (IR of tibia)
53
Q

Hx for PFPS (3)

A
  1. athletes
  2. female
  3. insidious onset
54
Q

PFPS symptomology (4)

A
  1. anterior/peri-patellar knee pain
  2. aggravated with:
    • prolonged sitting
    • stair ambulation
    • inclined walking
    • squatting
  3. knee crepitus
  4. catching at knee
55
Q

Physical exam findings for PFPS

A
  1. patellar alta/baja
  2. abnormal Q-angle
  3. painful squat
  4. possible peri-patellar swelling
  5. possible antalgic gait
  6. painful/limited knee ext and ext AROM
  7. painful/limited knee flexion PROM
  8. painful/weak knee ext
  9. Hip ER and ABD weakness
  10. Painful/hyper vs hypomobility PF joint
  11. (+) Clarke’s

Musculoskeletal 2 (7 decks)

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